When the Supreme Court makes a ruling, legal reasoning on the subject of that ruling does not stop. Lower courts begin to interpret and apply the precedent, and to shape what that ruling really means. District of Columbia v Heller is no exception. Courts have ruled on 2nd Amendment issues several times in the years since. These rulings are fleshing out a lot of the vague areas of law that the Heller decision did not address.

In both the Heller and McDonald (a case that extended the Heller ruling to the states) opinions there were several regulations mentioned as specifically allowable. A review of post-Heller legal cases found that more than 80% were decided in favor of the challenged gun regulation on the basis of a specific inclusion in the Heller opinion.

One ruling on these types of regulations occurred as a result to a challenge to New York gun laws prohibiting possession of “assault weapons” (defined by the law in New York in a manner stricter than the norm), expanding background checks and limiting the magazine capacities to a maximum of seven rounds. The court found that the assault weapon ban was reasonably connected to the cause of public safety. It did, however, strike down the capacity limit.

Another ruling in favor of gun regulations occurred as a result of a new challenge to Washington DC’s stringent gun control laws, revised after the Heller decision. This challenge was brought forth by the same man who originally challenged the laws, and has become popularly known as Heller II. In Heller II, the district court ruled that the District’s strict licensing requirements for firearm ownership did not violate the Second Amendment.

There is no clear test for determining the constitutionality of gun control laws. Judges use several tests to determine if a law is unconstitutional, and the one that applies the highest standard is known as “strict scrutiny.” While some courts have applied this test, no gun control laws have been overturned under “strict scrutiny” since Heller. Instead, courts using this test have allowed for the laws to exist due to public interest as well as “specific tailoring” to classes of people at higher risk for violent behavior.

Judges have used many different tests and forms of logic in determining their rulings post Heller. Without specific guidance from the Supreme Court, it is likely that the nature and limits of Second Amendment rights will continue to be a confusing question for the Federal courts. However, the overall picture painted by the judiciary thus far is that gun control laws in America are almost always constitutional. Many gun rights activists celebrated the decision in Heller, thinking that it might lead to a wave of gun control laws being overturned. Instead, it appears that the decision simply provided a rather high limit on how far gun regulations can go.

More than 7,000 children and teens are injured or killed by firearms every year. Given the steadystream of tragicnewsstories about children finding unlocked guns, you would think it makes sense for pediatricians to ask parents whether they keep their guns locked up. But doing that requires pediatricians to ask whether the parents have any guns in the first place.

In Florida, that’s against the law. At least since June 2011, when Rick Scott signed into law the Florida Privacy of Firearm Owners Act.

You might think such a law would violate the First Amendment by restricting physicians’ right to free speech. Or, at least that’s what a bunch of physicians thought. Along with several Florida doctors, the state chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians sued the state of Florida for a law they claimed violated their right to free speech (which appears to include their right to pass along data in professional policy statements such as this one on firearms).

However, in a 2-1 ruling (pdf) today, a federal appeals court upheld the Florida law, arguing that a doctor’s questions about firearms violated a patient’s right to privacy. “The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care,” the majority opinion stated.

But what is the Florida Legislature doing deciding what’s necessary or unnecessary to a patient’s care? The problem is, good medical care always requires taking into consideration ways to reduce the risk of injury or death. When we choose our doctors, we let them ask us questions about private family issues in exchange for their help managing our family’s health. There is no reason asking about firearms should be any different than asking parents whether they keep their household chemicals and medications out of children’s reach.

Professional medical associations in the U.S. agree that firearm violence represents a major public health problem in the U.S. Given that the U.S. has the highest rate of gun ownership and of firearm deaths and injuries in the developed world, it’s pretty hard to argue that point. Physicians are the stewards who help address public health issues. Arguing that a doctor’s questions about a family’s ownership of firearms violates the family’s right to privacy is akin to arguing that asking about the presence of lead paint – a standard well-child screening question – is a violation of their privacy. Why is it the doctor’s business whether a family has lead paint in their home? Because it presents a risk to children. So do firearms, so why are they any different?

The AAP thinks firearms in the home should be treated at least as seriously as lead paint. In a statement released today following the decision, James M. Perrin, MD, FAAP, the president of the AAP, said the following: “State legislatures should not stop physicians from practicing good medicine. This law has a chilling effect on life-saving conversations that take place in the physician’s office. More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility.”

The president of the Florida chapter of the AAP, Mobeen Rathore, MD, FAAP, issued a similar statement: “We strongly disagree with the 11th Circuit’s decision. It is an egregious violation of the First Amendment rights of pediatricians and threatens our ability to provide our patients and their families with scientific, unbiased information. This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients.”

Ten other states have laws similar to Florida’s introduced in their legislatures. The plaintiffs have said they will appeal the case to the 11th circuit court.

When tragedies occur, one of our responsibilities as parents is to help children process the event and provide them with the appropriate lenses through which to see the incident (if not understand it, since such things are rarely truly “understood”). It is absolutely essential that in doing this, we do not allow our children to absorb inaccurate and damaging ideas, propagated by an irresponsible media machine and blogosphere as well as countless Internet comments, about links between violence and mental illness and/or developmental disabilities when no evidence exists for such a link.

Hence the following important points:

1) Asperger syndrome is not a mental illness. It is a developmental disability.

2) Asperger syndrome is not associated with violence. At all. In any way. In fact, someone with Asperger syndrome is far *less* likely to commit a violent crime than someone without it.

3) A person who commits mass murder is not automatically/by default mentally ill (much as some might wish it so).

4) The mentally ill are many times more likely to be a victim of a violent crime than the non mentally ill, and they are statistically less likely to be a perpetrator.

5) Drawing spurious armchair-diagnosing conclusions about a person’s mental health and his or her violent acts, without evidence, harms the mentally ill.

6) Persons with developmental disabilities are more likely to be the VICTIM of a crime than a perpetrator. And drawing spurious armchair-diagnosing conclusions about a person’s developmental status and his or her violent acts harms those with developmental disabilities.

Following the Newtown shootings, and now following this most recent shooting in Santa Barbara, the news has been contaminated with bogus connections between the shootings and the mental and/or developmental status of the shooter. The former can certainly be relevant when kept in context and when confirmed (rather than springing from online amateur armchair-diagnosing). The latter – developmental status – is irrelevant.

There were reports that Adam Lanza, the Newtown shooter, had Asperger syndrome, which actually no longer “officially” exists in the new DSM-5 but is nevertheless considered on the spectrum of autism disorders. That diagnosis has since been legitimately questioned, but even if true, it is not relevant to his committing a crime. Now, the Santa Barbara shooter has been supposedly labeled with Asperger syndrome by his family’s attorney, who then retracted the statement and clarified in an LA Times story: “Astaire [the lawyer] said Elliot had not been diagnosed with Asperger syndrome but the family suspected he was on the spectrum, and had been in therapy for years. He said he knew of no other mental illnesses, but Elliot truly had no friends, as he said in his videos and writings.”

Note that the writer here erroneously wrote “no other mental illnesses,” as though Asperger syndrome were a mental illness. It’s not. Further, any news articles which speculate on Elliot Rodger’s mental health history would be violating the new guidelines issued by the Associated Press following the Newtown shooting. Such speculation, as that link explains, is further stigmatizing and damaging to those with mental illness, who commit only about 4% of all violent crimes. That speculation is also damaging and stigmatizing to those with developmental disabilities, such as autism, when the developmental disorder is inappropriately linked to violent crimes.

Asperger syndrome and/or autism spectrum disorders are NOT mental illnesses. They are also NOT linked to violence. Mental illness itself is NOT linked to violent crime in and of itself. That does not mean we should ignore the mental health status of mass shooters, nor does it mean we do not need better mental health services in this country (we do), but we should also pay attention to the only common denominator that IS evident in these incidents – that they are carried out with the same instruments. For example, the presence of a gun in the home greatly increases the risk of a violent death in that home.

Folks with much more knowledge and information that I have on this topic have already written about it at length, so I’ve provided below some essential reading when it comes to the intersection (or lack thereof) of mental illness, autism and violence. Emily Willingham, in particular, has written some of the best pieces on this, including the following quote from this piece, just days before the Santa Barbara shooting:

“Evidence-based studies examining established commonalities among people who commit crimes like this can be enlightening, but wild speculation and retrospective diagnosing do nothing useful and can cause considerable harm to law-abiding people who carry any of these labels, whether autism, schizophrenia, bipolar disorder, or others that have been suggested. Autistic people are people, and like other people, some tiny percentage of them can engage in violent behaviors, although overall, they “almost never” target anyone outside their families, plan the violence, or use weapons. There is no single or even group of diagnoses that explains or predicts the horrific behavior of mass murderers. And some unsupported assumptions about autism–such as the continued canard that autistic people lack empathy (they do not) – help no one and certainly don’t guide us to way to prevent such tragedies.”

A similar piece about the same irresponsible study was written by an autistic disability rights activist.

An excellent piece from a father also discusses many of the misunderstandings about Asperger syndrome.

Facts

The disabled, including autistics, are more likely to be the victim of sexual assault than the non-disabled.

This study shows that those with autism spectrum disorders and/or obsessive compulsive disorder are less likely to commit a violent crime than typically developing individuals.

A statement from the Interagency Autism Coordinating Committee at the US Department of Health and Human Services states: “There is no scientific evidence linking ASD with homicides or other violent crimes. In fact, studies of court records suggest that people with autism are less likely to engage in criminal behavior of any kind compared with the general population, and people with Asperger syndrome, specifically, are not convicted of crimes at higher rates than the general population (Ghaziuddin et al., 1991, Mouridsen et al., 2008, Mouridsen, 2012).”

Last weekend, the National Rifle Association celebrated “youth day” at their annual convention. The event offered free membership to children and a chance to win a rifle or shotgun. Since last weekend, there were many tragic incidents involving youths and guns. Here’s a summary:

Past research has shown us that improving the safety of motor vehicles led to a drop in children’s car accident deaths. A new study in Pediatrics proposes that preventive policies directed at reducing gun injuries among children could likely lead to fewer deaths as well – and such policies are much needed considering the study’s main findings.

The study found that one third of the children who died from gunshot wounds died before ever reaching the hospital — and that one in every five children who were shot died.

The researchers examined all 9-1-1 calls related to children’s injuries in five geographical areas to assess how firearm injuries compared to other types. More than 29,000 children under age 19 died from gunshots from 2001 to 2010, the authors noted.

Gunshot injuries accounted for only 1% of all children’s injuries that were called into EMS — but they accounted for one fifth of the deaths. Photo by Robert Linder

There’s good news:

Following a peak in gunshot injuries in 1994, firearm deaths in children dropped by half (55%) by 2003.

The study found that firearm injuries accounted for only 1% of all the injuries to children leading to a 9-1-1 call.

But there’s bad news too:

Since that decline, firearm-caused death rates for children have stagnated since 2003.

21% of the children in this study who died had been shot — making firearm deaths proportionally the highest death rate of all injuries.

Or, more plainly, kids who were shot were far more likely to die than kids injured in any other way.

Briefly, here’s how the researchers conducted the study: First they looked at all EMS and 9-1-1 calls coming in to 47 EMS agencies that serve more than 2.2 million children. The agencies cover emergency transports to 93 hospitals in the rural, suburban and metropolitan areas of five geographical regions: four counties around Portland/Vancouver on the Oregon/Washington border; King County in Washington; Sacramento, Calif.; Santa Clara, Calif.; and Denver County, Colo.

With this data, the researchers then determined what the injuries were for all children up to age 19 (a total of 49,983 children) calling in to those EMS centers. Then they compared the severity of injuries, major surgeries, blood transfusions, deaths and overall costs per child in each of six injury categories: gunshot, cut/piercing/stabbing, car accidents, getting hit by a car, falls, blunt objects and “other.”

Their main findings were sadly unsurprising: “Gunshot injuries were more severe, requiring more frequent major therapeutic interventions and resulting in higher mortality and per-patient costs than any other injury mechanism.” In fact, a child arriving at the hospital with a gunshot wound was four times more likely to die (8% in-hospital death rate) than a child coming in with the next most deadly injury, piercings and stabbings (2% rate).

Consider some of the specifics:
• Children with gunshot injuries represented the highest proportion of severe injuries (23% of all the injuries categorized as most severe were due to firearms)
• Abdominal/pelvic injuries and extremity injuries were proportionally far more common among gunshot victims than among victims of any other injury
• One third of all the children who required major surgery (of total injuries) had been shot
• Firearm victims were more likely than those injured any other way to need a blood transfusion

Although the rate averaged across all regions was 7.5 gunshot injuries per 100,000 children, the rates varied dramatically from one region to the next: from 2 cases to 31 cases per 100,000 children. The vast majority of gunshot injuries afflicted older teens, aged 15 to 19, who comprised 83% of all firearm injuries (though this age group only comprised 49% of total injuries of any kind). In addition, 84.5% of the firearm injuries occurred to males, though males were involved in only 59% of total injuries of any kind.

And getting shot is pretty expensive too. The highest per-patient average cost for any of the injuries was $28,510 — the average medical costs for treating children who had been shot. The next highest amount was for car accidents but was almost half as much: $15,566.

“These comparisons illustrate the immense per-patient impact of gunshot injuries in children,” the researchers wrote — yet these costs do not include any costs outside of the hospital. They do not include long-term outcomes, additional medical costs in follow-up or physical therapy, costs related to PTSD or other mental health repercussions, lost productivity in the children’s futures, lost productivity to society for the children’s deaths, lost productivity and related costs to the family, friends and other community members who grieved or were otherwise affected by these injuries and deaths, court costs in any cases that were filed as a result of the cases…

Like any study, this one throws a lot of numbers at us, but the big takeaway is pretty straightforward: firearm injuries may be relatively rare compared to other major injuries among children, but gunshots account for one in five deaths among children and have enormous personal, medical and financial impact.

But that does not mean the situation is hopeless. “Lessons in improving car motor vehicle safety (eg, booster seats, age-appropriate restraint systems and seat position, air bags) and the associated reductions in pediatric motor vehicle mortality provide important examples of the potential impact of injury prevention efforts,” the authors wrote.

If we can make it less likely for a car accident to kill children through smart, evidence-based policies, then we should also be able to develop smart, evidence-based policies that reduce children’s likelihood of dying from guns as well.

This study was funded by the National Institutes of Health, the Robert Wood Johnson Foundation, California Wellness Foundation, the Oregon Clinical and Translational Research Institute, the University of California Davis Clinical and Translational Science Center, the Stanford Center for Clinical and Translational Education and Research, the University of Utah Center for Clinical and Translational Science, and the University of California San Francisco Clinical and Translational Science Institute.

This is the key question so many of us involved in the gun debate face. On a personal level, answering it has big implications for our families’ safety. As Amy discussed in a recent post, having a gun in the household increases the chances that someone in the household will die by gunshot, though even in households with guns there are many things you can do to keep your kids safer.

But what about across the country? At the national level, the question has big implications for our country’s laws. Many people carry concealed or unconcealed weapons in public places out of fear of crime. Some people argue (see, for instance, here) that laws that allow easy access to guns and that allow guns to be carried in public places in the United States help to keep crime rates down. A recent study in TheAmerican Journal of Medicine – one of our country’s most prestigious sources of cutting-edge research in medicine and public health – concludes that that the answer is decidedly “No.”

The authors of this study examine rates of firearm ownership in 27 developed countries: from culturally relatively similar ones like Australia and New Zealand, to culturally quite different ones such as Japan. They also consider rates of major depressive disorder in those countries. Then they ask how firearm ownership and mental health problems in each country are related to the crime rate and the number of firearm deaths per person.

What they find is striking: the more guns in a country, the higher its rate of firearm deaths. The relationship is very strong, and holds up even when you don’t consider the countries at the extremes, such as the United States (high gun ownership, high firearm death rate) and Japan (low gun ownership, low firearm death rate). No matter how you slice the data, the more guns a country has, the more likely the average citizen is to die by gunshot. By contrast, there is a small, statistically significant relationship between mental illness and rates of gun deaths, but the association is very weak.

But some people might say that even if more guns means more gun deaths, criminals will be less likely to strike in countries where they fear that their potential victims could have a concealed weapon. In other words, maybe crime rates go down at the same time that would-be criminals are more likely to get killed. Unfortunately, once again the authors find that the answer is “No.” They find that there is no relationship between the number of guns per person in a country and the country’s crime rate. The U.S. happens to have a lot of guns and, in recent years, pretty low crime rates. But Japan has very few guns and even lower crime rates. And the UK and Israel have fewer guns than the U.S., but more crime.

Surely there must be some cases in which the presence of guns helps to prevent a crime, or in which potential victims kill would-be attackers. Still, this study has a very clear conclusion: on average and across the developed world, having more guns does NOT make countries safer.

Over the Labor Day weekend, I stopped my one-year-old from pulling all the books off the bottom two shelves of the living room bookcase three times. He managed to chew up two twigs and a walnut that had fallen off the tree in our yard, and he ingested unknown quantities of dirt. In a split second in which I turned my attention elsewhere, my three-year-old pushed his little brother down the stairs.

Luckily, everyone’s okay, and I think we’ll safely avoid a visit from Child Protective Services. We have carpeted stairs, the books are easily replaced, and the baby won’t die from any bugs he might possibly have ingested with the dirt.

In recent months Americans have been shocked by a number of incidents involving young children and guns – incidents that didn’t end nearly as happily as my children’s little mishaps over Labor Day. In Kentucky in early May, a five-year-old boy shot and killed his two-year-old sister. A couple of months later in the same state, a four-year-old boy shot and killed his six-year-old sister. And in New Orleans in July, a five-year-old girl killed herself with a weapon she found in a bedroom. Last month, a California SWAT officer was shot in the thigh at a children’s reading event when an eight-year-old boy somehow managed to pull the trigger on the officer’s holstered gun. Just this Saturday, an 11-year-old girl accidentally shot and killed her stepfather while he was showing off his new gun.

Anyone with a young child knows that the moment the kid starts really walking, all bets are off – kids are little and squirrely and can get into trouble in the blink of an eye. You’re stirring a pot of oatmeal and turn away from the stove to answer the phone. Your husband interrupts you, and for a split second you forget that you were about to tell your child to climb off that table, NOW! When you have several young children, or you need to get other things done around the house, or – God forbid – you are sleep deprived and sick, it all gets that much harder. It’s easy to second-guess the parents whose children fired the guns. In hindsight, maybe a parent shouldn’t have stepped into the backyard for a second. Maybe the eight-year-old California boy’s mom or dad shouldn’t have let him get that close to the officer’s gun. As a parent of two young boys, though, I tend to think this is asking parents to be superhuman. The only thing that’s kept my kids from shooting themselves or someone else is that there’s no gun around.

Even ammunition by itself can be dangerous. Young children may think bullets, like walnuts and twigs, look interesting to put in their mouths. Kids have died trying to tamper with bullets, or bang them on rocks, or hit them with hammer and nail.

It would be nice to think that gun safety would get easier once the kids get a little older and better at following directions. The Eddie Eagle rules are targeted at kids pre-K to third grade. They’re simple, clear, and easy to memorize: “If you see a gun, 1.STOP! 2. Don’t Touch. 3. Leave the Area. 4. Call an Adult.” The rules are great, one of the things for which the NRA should really be commended. The trick is to get your kids to follow the rules when you’re not around. Research shows that just telling kids the rules isn’t enough (also see here). You need to reinforce the message frequently, using active-learning and role-playing. It’s best if you practice the skills in the same kind of place where your child will encounter the gun.

Unfortunately, a study has found that even pre-teen boys whose parents talk with them about gun safety – and even ones whose parents think they’re not at all interested in guns – can’t really be trusted alone in a room with a gun. In a study that should send shivers down the spines of parents everywhere, medical researchers observed pairs of boys waiting in a room for 15 minutes. In a drawer in that room, the researchers had planted a handgun with a sensor on the trigger. Of the 29 groups of boys they studied, 72% found the gun. Among the kids who found the gun, three-quarters of the groups picked it up and touched it, and in half of the groups one or both kids actually pulled the trigger. The kids’ behavior was totally unrelated to their parents’ perceptions of how interested their kids were in guns, or to whether the kids had had gun safety instruction.

So the pre-teen years are obviously a problem. Maybe by the time my boys are teenagers they’ll be better at self-control and following gun safety rules? Unfortunately, right at this point adolescent hormones spike. Surely my boys will understand the rules by this point. But this is exactly when peer pressure is worst. In fact, peer influence is, I would guess, a big part of the reason the pre-teen boys in the study I discussed above behaved in ways their parents didn’t expect, and in contradiction of the gun safety rules they’d been taught.

Adolescent depression might be even worse than peer influence. Having a firearm in the home increases the risk of a teenager committing suicide – if firearms are removed from the home, some youth will commit suicide by other means, but many won’t. Studies of suicide attempts show that suicide is, despite its finality, usually impulsive. Tragically, however, impulsive suicide attempt are likely to be deadly when the weapon is a gun – between 78 and 90% of gun suicide attempts are fatal.

Many parents strongly believe that having a gun in the home is the safest way to protect their kids from danger. Unfortunately, though, evidence suggests the opposite – kids who live in homes with guns are actually more likely to die by gunshot than are kids living in homes without guns. As a result of this evidence, the American Academy of Pediatrics has taken a strong position on guns and kids: “The safest home for children and teens is one without guns. If there are guns in the home, scientific evidence shows the risk of injury or death is greatly reduced when they are stored unloaded and locked, with the ammunition locked in a separate place.”

So how can we keep our kids safe from themselves when it comes to guns? In a world where guns are plentiful it may be almost impossible to completely protect our children. Still, here are some general guidelines that I’ve picked up.

Follow the advice of this country’s flagship association of pediatricians. If possible, taking into account your family’s lifestyle and needs, keep guns out of the house entirely. If that’s not possible, follow their advice and keep your gun(s) stored unloaded and locked. Keep the ammunition in a different place, also locked up.

To the extent possible, try to keep guns out of your child’s environment when he or she is away from home. If your child is at a home daycare center, ask the provider if she has a gun in her house. If your child goes over to a friend’s house on a play date, ask if the friend’s parents have a gun in the home. At your child’s public school, talk with the PTA about devising a plan to keep children from bringing guns into the school.

You need to exercise special caution if you have a teen in the house who develops symptoms of depression. Teens are watchful and resourceful and they often know much more about how to get access to supposedly secured weapons than their parents realize. Even if the teen is well trained with firearms, intelligent and responsible, the best idea is to get the guns out of the house altogether – sell them or ask a responsible relative to store them (locked up) in another house to which your depressed teen doesn’t have access.

Build in redundancies. Well-meaning, caring adults sometimes forget and, despite the best intentions (as well as penalties for negligence in a few states), they leave weapons in places where children can find them. As your child gets older, he or she will spend less time with you and in places you can monitor. You need to think about what your child will do if or when he or she encounters a gun.

- Drill the Eddie Eagle rules: “If you see a gun, 1.STOP! 2. Don’t Touch. 3. Leave the Area. 4. Call an Adult.” Talk about them. Repeat them regularly. Make sure your children understand them. Check for comprehension. Practice them by role-playing scenarios in which you find a gun.

- Always assume that any gun around is loaded, and treat it accordingly. Even if you yourself emptied the chambers, still assume it’s loaded. Mistakes happen, and people are human – tired, forgetful, rushed. Almost daily, we hear stories of accidents, often tragic ones, explained by someone who says, “I didn’t know it was loaded.” This rule should mostly apply to grown-ups, since kids should NOT be touching guns without adults around. Still, if there are guns in your household, it’s an important rule for EVERYONE to keep in mind.

- Some people recommend teaching your child to shoot. They argue that doing so will help your child learn to handle a gun safely, and will make her less curious about touching a gun if she encounters one. This might be logical, but I can’t find any research that shows whether such a strategy is effective. One study, however, did find that kids with guns in their homes were more likely to touch a gun in a risky, unsupervised situation. Gun researchers all endorse the Eddie Eagle rules as the single most important way to keep your kids safe around a gun. If you do teach your child to shoot, make sure you emphasize guidelines for gun safety – and most importantly, that you still rehearse the Eddie Eagle rules regularly.

There were too many shootings over the holiday weekend to include in a single graphic. Even after leaving out multiple-victim shootings that occurred on Monday, there were an additional seven shootings left off this graphic that occurred Saturday and Sunday: two were shot in Camden, NJ, three in Buffalo, NY, two in Hartford, CT, two in Bergenfield, NJ, two in Hamilton, OH and two in Palo Alto, CA. This post will be updated later with links to all the incidents referred to in the graphic.

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